Earlier this year, in Issue 107, I wrote about a two-month-long experiment where I drastically distanced myself from all current events and news media. Though I’ve never been a news junkie and loath all politics, I am curious and want to learn, so I spent a few years attempting to balance the wave of fear and doom by listening to science-education podcasts like Huberman Lab, following good news Instagram accounts, and subscribing to Wired magazine.

Just before starting this experiment, I’d also come off a long stretch of health-related inquiry after learning I carry the BRCA gene. In my spare time, I was reading books on longevity, distilling the pros and cons of preventative mastectomies, and annoying the hell out of a genetic counselor by asking who funds the institution that recommends annual mammograms and MRIs for folks with BRCA, despite conflicting research that indicates excessive radiation from mammograms could actually be harmful for BRCA carriers because “Women who carry deleterious BRCA mutations have an impaired ability to repair damage that arises in the DNA that makes up genes…the small amount of radiation exposure due to a mammogram – essentially an X-ray – can contribute to DNA damage.”

The National Cancer Institute is government-funded by the way, which is a benign way of saying it’s run by lobbyists. This isn’t necessarily bad—most research is publicly funded—but let’s not pretend we’re frolicking in a field of altruism. Cancer is big business. My experience in the world of mental health x pharmaceutical influence means I cannot approach a health issue without looking to see who is pulling the narrative strings. A guideline is never just a guideline. It always comes from somewhere. Typically, the end point is a multinational organization that oh so coincidentally makes a lot of money off of the story being told (Coca Cola funding, influencing, and owning the URLs of anti-obesity groups) or a wartime guideline that no one ever bothered to dig into. The Recommended Dietary Allowances of nutrients, for example, were introduced during World War II in order to advise “on nutrition problems in connection with national defense.” This was about the minimum required to survive another day of battle. Yet, every nutrition label and marketing scheme still reflects these antiquated numbers.

Knowing how all this works, my personality left me with only one choice: go HAM on my own reading and research.

I found a functional medicine doctor and ran dozens of labs, listened to health and longevity podcasts while driving, and read the latest books on preventative medicine and mind-body health. My diet, which already underwent a big overhaul in 2021, tightened up in the most unexpected of ways: more red meat, fewer vegetables, no seed oils, and little to no alcohol.

I’ll never know how, or if, these changes actually prevent or delay a cellular oopsie. Carrying the BRCA gene does not guarantee mutation. But all the research and changes gave me a sense of control over the situation…until it didn’t.

We glorify learning, as if knowing more information is always the right call. But knowledge has diminishing returns; there comes a point where you know what you need to know, and knowing more actually causes more issues because it interferes with your intuition. Yes, I had gained a rudimentary understanding of one possible health future. But I was also fried, anxious, and no closer to figuring out what in the hell to do about it.

So I decided to stop learning.

Midway through the year, fresh off the unexpected glory of staying away from all news and current events, I put myself on a learning embargo for an undetermined amount of time. No more doctor’s appointments. No more medical books. No more podcasts. No more fear-based learning. I was to be purposefully dumb!

My god, what freedom. Between no current events and no learning, all my free time went to reading fiction, painting, and running in the hills. I listened to music while driving, found a group of old men to play chess with on Saturday afternoons, and used up all the hot water during daily, mind-wandering showers.

In time, I came to find a sense of peace around my persnickety genetics. If it becomes something I need to deal with, I trust myself to deal with it. In the meantime, I know I’ve made the best changes with the information I have in order to give myself the best shot of never having to deal with it. Really, what more is there to do?

All this to say, look at your life. Where might it be beneficial for you to actually learn less? Consider it addition by subtraction. In going on a learning embargo, I wasn’t practicing denial. Instead, I was making room for integration, understanding, and the quiet voice that always knows.

A new study on publication bias of the benzodiazepine Xanax has been released. According to researchers from Harvard, Massachusetts General Hospital, McLean Hospital, and former FDA reviewer Eric Turner, four of the five original studies on the effectiveness of alprazolam (Xanax) found it to be no better than a placebo. Furthermore, only one of the five studies reviewed by the FDA showed a positive result. It is curious when you consider that the FDA “expects that the drug maker will submit results from two well-designed clinical trials to be sure that the findings from the first trial are not the result of chance or bias.”

Publication bias is the practice of picking and choosing what gets published and how it gets published. This is extremely common across all hard and soft scientific disciplines, and it’s a big reason why relying on published, peer-reviewed research should not be the be-all, end-all of human existence.

Negative and neutral trials, for example, often don’t make it into literature. Not only do the researchers not want to draw attention to a failed hypothesis, but journals don’t want to waste space on science that doesn’t work. Furthermore, the media rewards breakthroughs, not duds. Thus, an unknown amount of research is left on the cutting room floor.

The problem with this is that when you look at the body of research that does get published, it tells a very different story. British physician Ben Goldacre explains it well. I’ve fast-forwarded to the most relevant part for your convenience:

This is exactly what happened in the Xanax approval process. The FDA received data on five Phase 2 and Phase 3 trials. They considered four of them to be negative but approved the drug due to the strength of Study 2. Furthermore, the results of Study 1 were spun to look positive, despite the FDA statistician determining the study failed because improvement was not noted in all seven primary endpoints (the FDA deems “studies positive only if all primary endpoints achieve statistical significance”).

Studies 3, 4, and 5 failed or were nonsignificant, and none of these studies were published.

Thus, the published literature reflected that Xanax was a successful intervention for panic disorder, which led to a frenzy of prescriptions thanks to media and marketing departments that use published literature for headlines and campaigns.

And here we are, thirty years later, with a raging global opioid crisis, in part thanks to the misuse of benzodiazepines.

You know Big Pharma is prepping to push a new class of drugs when the narrative starts changing around the golden pharmaceutical children of yore.

Drug patents in the United States typically last 20 years, and given that there’s been no meaningful pharmacological advance in the mechanism of antidepressants during that time, most SSRIs and SNRIs have fallen off the patent cliff and are available in generic form. Generics, of course, don’t bring in the dough. So, pharmaceutical companies use a variety of tactics to bury generic competition, including but not limited to:

Two themes are appearing in the media that make me think we’re heading for a classic shift. First, we’re seeing headlines about new antidepressants, specifically Zurzuvae (zuranolone) and Zulresso (brexanolone), both of which act on GABA receptors (like benzodiazepines) and are being targeted at vulnerable new mothers with postpartum depression.

Zulresso, by the way, costs $34,000.

The New York Times reported on these new drugs on August 4, 2023. On November 9, 2023, the New York Times also reported on Post SSRI Sexual Dysfunction, a devastating and often permanent side-effect of antidepressants that can rob people not their libdo, function, and feeling in their genitals. Chemical castration, effectively.

Both articles include a pithy offer of journalistic objectivity, adding a quote or two from the “opposition” to satisfy the reader with an attempt at balance. But the tone of each article is clear: New shiny drugs, good! Old generic drugs, beware!

Curioser and curioser.

In good news, SNOMED (Systematized Nomenclature of Medicine Clinical Terms) has created code 1285639002 for “Protracted antidepressant withdrawal syndrome (disorder).”

SNOMED is a non-profit organization responsible for determining global standards for health terminology. It is designed to support a wide range of healthcare processes, including clinical documentation, decision support, and data analysis. It encompasses a broad spectrum of clinical concepts, relationships between them, and associated terms. This standardized terminology helps ensure consistency and interoperability in health information systems.

Without a formal code, an ailment essentially doesn’t exist. That means that prior to code 1285639002, precisely 0 cases of protracted withdrawal have been formally recorded because there wasn’t a way to do it.

In the UK, doctors have to activate the code in order to use it. Once that happens, researchers will be able to start tracking case rates. In the US, it’s irrelevant because of our dumbass system. I’m told that we likely won’t have a code until the DSM recognizes it, which would lead to a bit of the emperor has no clothes situation. But SNOMED is a start, and I’ll take it.

On October 9, 2023, the United Nations and World Health Organization jointly released a 184 page report addressing the massive human rights violations that occur in mental health “care” all over the world—including the United States and Canada.

After looking through the document, I’m at a loss for words. I’ve spent years speaking alongside other titans, all of us trying to blow the whistle on the corrupt, evidence-less, biomedical model of mental illness that leads to detrimental over prescription, forced institutionalization, and “treatment” without consent. This work has opened all of us up to a special portal of hell, where defamation, academic mobbing, death threats, and the constant risk of getting sued is always on the mind.

(Never have I been so happy to not be associated with an institution. I have a lot more latitute to speak freely when I am not at risk of losing a license or my job with a University.)

And yet, this is a 184 page report effectively says we were right all along. Addressing the harm of the biomedical model, it proposes new legal objectives and a clear mandate for mental health systems to adopt a rights-based approach as opposed to a containment-based approach. It also admits:

Mental health and well-being are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.

Imagine that! Living under constant threat, whether familial or political, isn’t the way to health and wellness. Whoda thunk?

Furthermore, the document goes into considerable detail on informed consent in psychiatric care, which is generally nonexistent in current practice. This manifests in a variety of ways, from involuntary psychiatric holds to general practioners handing out antidepressants after five minute appointments to psychiatrists refusing to support their patients in tapering from psychiatric drugs.

The document says, specifically:

Countries should adopt a higher standard for the free and informed consent to psychotropic drugs given their potential risks of harm in the short and long term. . . . Legislation can require medical staff to inform service users about their right to discontinue treatment and to receive support in this. Support should be provided to help people safely withdraw from treatment with drugs.

More than anything, though, I am shocked and impressed that the WHO and UN admitted the following:

An additional concern is the explicit use of a reductionist Western biomedical model in mental health law, which works to the detriment of other holistic, person-centred and human rights-based approaches and strategies for understanding and addressing distress, trauma, and unusual perceptions or beliefs (2, 86).

Reductionist Western biomedical model! My god, if this was a snark Substack, that statement would come with a dramatic reaction gif.

Actually, fuck it. My filters are gone.

It’ll be interesting to see how—and if—this document has any real impact on legistlation and operating procedure. I doubt there will be a rush to change any laws any time soon, at least in the United States, as long as Big Pharma continues to hold their lobbying power.

However, one major change is that for those branded with scarlet letters ranging from “dangerous” to “anti-medicine” to “anti-science” we can now point to this report for hard-to-argue-with evidence and support. As I’ve said all along, change on this front is not going to come from the top down. It’s going to start with each individual taking control of their own care, and finally, there’s a document to support it.

Download the report.

How small a thought it takes to fill a whole life. – Steve Reich

I have spent the last year bewitched by a singular thought. It began as a wonder, planted unintentionally by multiple people who independently came to the same conclusion, well before the idea ever dawned on me. There was—is—an energy behind the idea. Though it was slow to root, once it took hold, its vines tangled itself in every corner. The details are ever changing based on how the scenario is or isn’t playing out in my reality, taking me on a wild ride of highs and lows. As my mother put it, “It’s like you are on a river, rafting through rapids, completely unaware if you are heading towards a cliff.”

Another person is involved, of course. Isn’t that always how it is with these sorts of things. And they have no idea what I’m experiencing, of course. Because isn’t that always how it is with these sorts of things? And now is not the time to say anything, of course, because when it comes to these sorts of things, timing is everything.

So I sit. And think. And try not to think. And push it away and watch it come roaring back again.

It manifests in my body, sinusitis combined with a heaviness that creeps through my limbs. I cut through it by watching my dog frolick on a dirt path behind my home, willing myself to hear the birds while I observe her canine joy and force myself to think, “If this is my last moment on Earth, my God, it is beautiful.”

Another thought: Don’t decide your failures in advance.

There are two forces at work here. First, a lesson on perception. Due to the nature of the situation, most of it is playing out in my own mind. Over the past month, new information has come in that has me questioning my interperetation of the last year. My mental and emotional assumption of What Is has taken a sharp turn, veering away from one of hope and possibility to one of frustration and stupidity.

And yet, objectively, the situation has not changed. It is identical to what it was six months ago. All that has shifted is the story I tell myself. Still, it is maddening that I can’t find the line between intuition, instinct, and fantasy. That is not often a line I struggle to walk.

Which leads me to the second lesson, a perennial lesson it seems I am constantly forced to learn: the art of waiting.

Back in Issue 22, I wrote: We have conditioned ourselves to think that when we are presented with a choice, our only options are to pick one or the other and to do it fast. But there is an ever-present third choice that often holds the most power — the choice to wait.

I am fighting a sinking feeling telling me that I was wrong, that what I thought this was, isn’t. I want to chastize myself for being so foolish, box up the embarrassment of ever mentioning it at all, and pretend it never happened by engaging in whatever or whoever pulls me in to break up the thought pattern. But even if this path turns out to be true, it is too early to decide my failure. Frankly, there is little evidence to support the Stupidity Theory. But there is some evidence, albeit not an overwleming amount, to support the Original Theory. The truth is likely somewhere in between. I am sure I have overcorrected on both ends.

So I must wait and find a way to tend to the roots without letting the vine suffocate its host, one thought at a time.

When we left off in the early 20th century in the last issue of HIAS, A Brief History of Psychiatric Diagnosis, Part I, a few themes had emerged:

Keep these themes in mind as we explore the origin story of the Diagnostic Statistical Manual of Mental Disorders.

Though it was Richard von Krafft-Ebing and Josef Adolf Hirschl who propagated the biological model of mental illness thanks to their work with syphilis, it is German psychiatrist Emil Kraepelin who is most responsible for the genesis of the DSM and its stronghold over our modern psychiatric system.

Born in 1856, Kraepelin’s work began to attract attention in 1893. Kraepelin ran a clinic at the University of Dorpat and determined that because patients often showed similar symptom patterns, he could use those patterns to classify psychiatric disorders. For example, he observed that manic-depressive insanity did not deteriorate into dementia praecox (what we now call “schizophrenia.”) Dementia praecox, on the other hand, appeared in adolescence and progressed to dementia and institutionalization. One did not morph into another, indicating to Kraepelin that despite some similar symptoms, they were two separate ailments.

Kraepelin took this theory and applied it to all expressions of psychiatric distress that existed at the time. He coined the term “depression”, distinguishing it from the melancholia umbrella that had described human suffering for centuries, and separated the “paranoid thinking of schizophrenia” from “paranoia.” He was fixated on objectivity and measurability, eschewing notions of stress, environment, personality, and their potential impact on mental illness.

He was also a rampant eugenicist. A letter to the editor published in the American Journal of Psychiatry put it bluntly:

In a 1919 paper titled “Psychiatric Observations on Contemporary Issues,” Kraepelin proclaimed that “dreamers, poets, swindlers and Jews” possess “distinctly hysterical traits” and fall outside the bounds of normality, adding that Jews exhibit “frequent psychopathic disposition.”

Kraepelin died in 1926, but his belief that “reasonable policies of racial hygiene” were the solution to Germany’s “degeneration” problem deeply influenced Nazi ideology and the rise of the Third Reich.

While an obvious display of eugenics was playing out in Europe during the first half of the 20th century, the American Psychiatric Association (APA) was busy with a more inconspicuous systemization. In 1913, the APA set up a statistics committee that eventually took responsibility for classifying psychiatric diseases. Combining American observation with Kraepelin’s work, these publications ruled American psychiatry through World War II.

We need to pause for a moment in order to highlight an oft-ignored aspect of this early American classification. It must be noted that as reported by the American Psychiatric Association itself, “Between 1892 and 1947, 31 presidents of APA acted in leadership positions in eugenics organizations, during their time as president, but also in the years surrounding their presidencies.”

Let that sink in for a minute. During the time in which the foundation for all modern psychiatric diagnostic strategies was built, the people in charge of creating that system held the same beliefs as Hitler. Literally, your kid’s ADHD diagnosis or your bipolar diagnosis is rooted in the same categorization and rationale that led the Nazis to exterminate six million Jews.

Combine this with the Social Darwinist movement pervading white-collar industries at the time, and it’s no surprise that the intellectual elite worked to sort folks into acceptable and flawed stock. And don’t think this was an act of good intentions gone awry. Even the modern IQ test that we still use today, which was developed around the same time, is rooted in eugenics. Developed by noted American eugenicist Henry H. Goddard, the IQ test ranked those he considered “feebleminded” into three categories of perceived incompetence: pre-verbal “idiots” illiterate “imbeciles,” and high-functioning “morons.” According to a law review of the landmark murder trail Atkins vs. Virginia, which hinged on the definition of mental retardation, Goddard “found morons wherever he looked: criminals, alcoholics, prostitutes, and anyone ‘incapable of adapting themselves to their environment and living up to the conventions of society or acting sensibly.’”

But by 1948, though the foundation for systemization was already laid, German eugenic sentiments weren’t exactly popular among the collective. Thus, the APA asked its Committee on Statistics to rewrite the diagnostic system. A rebranding, if you will.

Spearheaded by George Raines, the first edition of the Diagnostic Statistical Manual of Mental Disorders pulled away from German language and theories, instead drawing from the en-vogue influences of Sigmund Freud and Swiss psychiatrist Adolf Meyer. Both Freud and Meyer attributed psychological distress to childhood experiences and in Freud’s case, sexual repression. Kraepelin’s symptom-based sorting system still remained, but because of this shift, psychotherapy dominated psychiatric thinking for a short time.

Right around the time the DSM-I was making its way into clinical practice, psychopharmacology was on the rise after the first mood-altering drug, iproniazid, was accidentally discovered in a tuberculosis ward in 1952. Iproniazid induced euphoria in terminal tuberculosis patients and phenomena so profound, the drug was given to 400,000 depressed people to see if it would have the same effect. It did, but it also caused the blood vessels to constrict to dangerous levels, and administration of the drug was stopped. However, its brief existence brought the chemical imbalance theory of mental illness back to the forefront, and the DSM-II was written with this in mind.

It is at this point that the “pill for every ill” strategy leaves psychiatric wards and enters the homes of everyday folks, in part due to the introduction of tranquilizers and benzodiazepines aimed at women in the early 1960s.

In the early 1970s, after the US/UK Diagnostic Project determined that American psychiatrists and British psychiatrists operated by wildly different criteria for diagnosing schizophrenia (a not-so-surprising twist given that there wasn’t and still isn’t any medical test for schizophrenia or any other mental illness), American psychiatry determined it needed to tighten up its diagnostic strategy.

Robert Spitzer, a biometrician at Columbia University, was assigned the task. It is Spitzer who came up with the checklist, in that in order to meet the criteria for a certain mental illness, the patient had to experience X symptoms out of a list of Y.

The DSM-III also introduced bipolar disorder, borrowing the term from yet another set of World War II-era German psychiatrists, Karl Kleist and his student Karl Leonhard. We all know where this leads. According to Edward Shorter, PhD., “The term went on to become among the most popular diagnoses in psychiatry, as well as the foundation of pharmaceutical fortunes selling ‘mood stabilizers.’”

The DSM-III also added attention deficit disorder to the lexicon, as well as post-traumatic stress disorder and a variety of anxiety disorders.

Shorter continues, “What psychopharmacology had begun, DSM-III finished off; the [psycho]analysts were shown the exit sign from the field, or at least from its commanding heights…the DSM-III began a rapprochement between psychiatry and the rest of medicine.”

Since the publication of the DSM-III in 1980, the “bible” of psychiatric diagnosis has been revised three times, with the DSM-V appearing in 2013. From a clinical level, little has changed in the world of diagnoses since the DSM-III appeared. Patients are still judged by a checklist of diagnostic criteria, psychotherapy and root cause are generally ignored, and no test, scan, or lab exists to confirm or refute a biological or chemical cause for mental illness.

One thing, though, is noticeably different. The size of the Diagnostic Statistical Manual of Mental Disorders has swelled with each edition.

The DSM-III registers at 494 pages and weighs 1.9 pounds.

The DSM-IV is 886 pages and 3.4 pounds.

The updated DSM-V, published in 2022, is 1050 pages and weighs 4.6 pounds.

He who knows syphilis knows medicine.

—William Osler, co-founding physician of Johns Hopkins Hospital

In 1885, the Boston Medical and Surgical Journal made an observation: mental asylums in the United States were full. The journal noted that the number of patients had risen dramatically, with people wandering the halls of asylums with a jerky gait, grandiose illusions, and dementia—a collection of symptoms deemed “general paralysis of the insane.”

On the rise, too, was syphilis. In its late stages, syphilis also creates a jerky gait, grandiose illusions, and dementia. In 1885, it was unclear whether the rise in the insane was due to pathological disease or other influences. But in 1897, a causal link between these symptoms and syphilis was found thanks to German psychiatrists Richard von Krafft-Ebing and Josef Adolf Hirschl.

Krafft-Ebing and Hirschl knew that syphilis could only be contracted once, so they created an experiment where they injected the pus from sores of syphilictics into people suffering from general paralysis of the insane. If the patient became infected, they could say with certainty that the patient had not had syphilis before. However, none of the subjects became infected with the disease, leading Krafft-Ebing and Hirschil to conclude that not only had all of their patients’ been previously infected by syphilis, but that it was a disease that caused their psychiatric symptoms.

Thus, the biological theory of mental illness was born. The connection between the biological nature of syphilis and the undesirable psychological side effects of that illness led researchers to assume that all expressions of mental illness boiled down to a biological malfunction. Given the first neurotransmitter wasn’t discovered until 1921, and more robust science on the matter didn’t appear until the mid 1950s, neurologists at the turn of the century instead focused on what could be observed in autopsies. However, little progress was made. Common psychological ailments of the time, like hysteria and shell shock, left no visible sign of brain tissue damage. This lack of biological evidence bolstered the theories of Sigmund Freud, the father of modern psychology, to say: “The case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science.”

The link between syphilis and mental distress came at a time when a concept called Social Darwinism was hitting its stride. Rooted in Charles Darwin’s theories—though he himself was not directly connected to the movement—Social Darwinists believed that human groups were subject to the same evolutionary principles as plants and animals. Natural selection and survival of the fittest could be applied to sociology, economics, and politics because, in their view, sociocultural ideals were inherently biological. Said another way, it was biology that determined if you were white, male, and physically fit, so therefore, natural selection should be applied. Practically, this meant that Social Darwinists believed the strong should see their wealth and power increase, while the weak should see their wealth and power decrease.

The connection between Social Darwinism and the rise of the global eugenics movement of the late 19th century and the first half of the 20th century is obvious: a group of intellectual white men decided the human race was “de-evolving,” and wielded their power and influence to reverse this perceived course by professing who should and should not bear children. This influence stretched into all white-collar industries, from major businessmen like the Carnegie’s and Rockefeller’s to legal theorists, academics, criminologists, and of course, psychiatrists.

The science—although “science” is a loose term given not a shred of evidence existed then or now to back up the theory—became so pervasive, that by 1914, 44 American colleges had introduced eugenics into their curriculum. Rooted in the language of protecting the average citizen from those who threaten the fabric of society thanks to inferior genes and beliefs (note the connection between the language being used at this time and the language surrounding both sides of modern American political movements), Social Darwinists pushed the idea that the species could not evolve if people of good stock mingled or procreated with undesirables. The undesirables, as you’ll remember from high school World War II history lessons, included everyone from Jews to Blacks to the “feeble-minded” and physically disabled.

As Dr. Boonie Burstow, Canadian feminist professor and psychotherapist wrote of the Social Darwinists a few months before her death in early 2020, “While they saw themselves as progressive and as following the dictates of modern science, what they were wrapping themselves in was a combination of hatred and pseudo-science for there was not a shred of credible evidence supporting their position.”

Again, note the connection between Burstow’s commentary on Social Darwinists of the early 20th century and the mental illness propaganda being pushed into the zeitgeist today.

It is at this time in history when the open practice of eugenics simultaneously becomes both obvious and insidious. In 1920, German psychiatrist and eugenicist Alfred Eric Koch and German jurist Karl Binding penned Die Friegabe der lernichtung Lebensunwerten Lebens, which translates to “Permitting the Destruction of Life Unworthy of Life.” This work directly led to the German T4 program, which allowed for the killing of disabled patients in institutions under the guise of mercy. In 1939, Hitler secretly signed an authorization protecting physicians and administration from any prosecution associated with the program. It was also this program that would develop the gassing chamber used throughout World War II.

To help identify who “qualified” for the T4 program, planners developed questionnaires that were distributed to patients in hospitals, old folks homes, and institutions. Worded and formatted in a way that appeared like a simple census to the average citizen, these forms were actually designed to parse out ancestry not of German blood, those suffering from schizophrenia, epilepsy, dementia, encephalitis, and other chronic psychiatric or neurological disorders, criminals, and those who had previously been institutionalized.

A group of prestigious physicians evaluated the forms and identified those deemed undesirable. After their identification, they were coerced from their institution and transported to their death in a gassing chamber. The families of the victims received an urn and death certificate noting a fictitious cause of death.

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In the next installment of A Brief History of Psychiatric Diagnosis, we’ll look at how the eugenics movement influenced the bible of all psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In May of this year, when I relocated to NYC for a few months, I started an experiment with an undefined end date: I made a commitment to create conscious, intentional distance between myself and all expressions of current events and mainstream media.

If a newspaper ends up in front of me, I toss it in the nearest recycling bin. If CNN blares at the airport, I turn my back and put in headphones. I no longer subscribe to any list referencing current events or outrage. I walk away from banal conversations or force a change in subject and delete the random videos people send me without watching them.

I cannot tell you what the weather forecast is without sticking my hand out the window. I don’t know who is throwing their hat in the ring for presidential nominations. When I found out about the Maui wildfires—on an instagram account dedicated to good news—my heart sank at the sight of it all, and still I immediately unfollowed.

There was a time when I thought that being up to date on current events is part of what made you a good citizen. Whether it was my uppity liberal arts education or my uppity liberal arts friends, I don’t know, but manufacturing my own interest in the world’s chaos felt like a duty I was obliged to perform. Perhaps, back when information was handed out in digestible bits through letters that took weeks to arrive and journalism that only delivered the news once a day, an overview of national and global happenings wasn’t so detrimental. A forty-five minute newspaper read was tempered by twenty three hours of distance. Gossip spread around town and provided for idle chatter, sure, but everyone was more or less getting the same information so I imagine there was only so much to say. And without the ability to tweet about whatever issue pissed people off, the incendiary nature of it all likely didn’t have enough oxygen to really catch fire. This allowed for the most collectively important issues rise above, leading to vast societal changes like the Renaissance, Women’s Rights Movement, and Civil Rights Movement.

My embargo exists to see what sort of movements I might experience within myself absent of noise imposed upon me. After all, can we really say that the life of someone who chooses to spend their time marveling at the beauty of a tree is any less meaningful than the person who spends their time picketing outside the Supreme Court?

The changes I’ve felt within myself have been profound in the most surprising and delightful ways. With so much mental and energetic space cleared up, I’ve been learning and creating at an unprecedented rate. Everything everywhere is art. The food I’m cooking for work has become bold, ambitious, and unapologetic—an adjective that might not seem to make sense in this context, but for me, is extraordinary. I am pulling away from the confines of painting lessons and tutorials in favor of following my intuition in a way that feels less like amateur experimenting and more like remembering how to do something I already know how to do. Even my physical body is responding. I am lighter, literally and figuratively. I am moving it in new ways that, like painting, feel like remembering.

Socially, I am both a better listener and more of a recluse. I haven’t been giving up my time to other people as easily, but when I do, I find I’m more objective. I can listen to what they have to say and, because I don’t have context filtered through some agenda, come to a conclusion or ask questions without as much judgement or assumption.

This is not entirely without its downsides. In July, I got stranded in Long Island for five days and missed a friend’s wedding thanks to a wave of airline disruptions due to storms on the East Coast. Had I been paying an ounce of attention, I might not have made a last minute change to my itinerary that caused me to attempt to fly on the day storms were predicted to be the worst. On the other hand, while I missed the wedding, I spent those five days in Long Island helping a friend who really needed that help. And I got to spend the time devouring a book I randomly pulled off the shelf, Born to Run, which in two back to back readings has transformed me from someone who thought I hated running to someone who is now going on hour long trail runs at whim, for fun.

Just yesterday, the writer Suleika Jaouad shared a prayer she threw up to the heavens in 2015: “May I be awake enough to notice when love appears, and bold enough to pursue it without knowing where it will lead.”

These words bring tears to my eyes as I type, not just in hope of romantic love, but in the courage that it takes to step forward while knowing less. Cutting ties with current events and mass media means I am forced to watch what comes up within myself. A few times, I have spiraled into a loop of worry over whether or not I’m making the right choices. Have I overcorrected? Am I going to miss something I need to know? Am I confusing my intuition with fantasy? Is not knowing what I don’t know leading me down the wrong path?

Bold enough to pursue without knowing where it will lead.

I can’t argue with the wonder that has come out of knowing less. And so, for now, I will continue to keep my distance and watch what comes in its place.

During my sophomore year at Middlebury College, I took notoriously tricky course called Introduction to Modern Logic. An early requirement for philosophy majors (one of the many declarative detours I flirted with before landing on the equally useless History degree), it focused on good reasoning and the technical breakdown of arguments.

A basic example:

If Bellaroo is napping on her dog bed, then Bellaroo is not taking a walk.

Bellaroo is napping on her dog bed.

Therefore, Bellaroo is not taking a walk.

The statement is true in all circumstances, regardless of time, interpretation, or the laws of physics. If Bellaroo is napping on her bed, she is irrefutably not taking a walk.

The point of this course is to help students identify patterns of good reasoning and patterns of bad reasoning, so they have a better idea of what to follow and what to avoid. The tricky part occurs when a statement seems true at first glance, but breaks down when logic is applied. These are called logical fallacies, and they are everywhere.

A few examples:

The Appeal to Ignorance, where we assert a claim because no one can prove otherwise.

People have been praying to God for years. No one can prove He doesn’t exist. Therefore, He exists.

The Bandwagon, where we assume something to be true or good just because many others believe it to be true or good.

Everyone at the gym is wearing Lululemon. I need to buy their yoga pants.

The Red Herring, were we use irrelevant information to distract from an argument.

There are starving children in Africa. Eat your broccoli.

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Psychiatry, more than any other branch of medicine, is saturated with logical fallacies. Hell, we can apply all three of the above examples to cultural rationale within the world of psychiatry and mental health:

The most pervasive logical fallacy in psychiatry and mental health diagnoses, though, is circular reasoning, which is an argument that uses the same statement as both the premise and the conclusion.

The reason why circular reasoning is so pervasive in psychiatry compared to other specialties is because psychiatry doesn’t have any form of objective boundaries. The rest of medicine, generally, agrees on parameters that define a pathological disease. Diabetes in the United States is only diagnosed as diabetes when two fasting A1C blood sugar tests read 6.5% or higher. Doctors—and even different countries—debate 6.5% as the cutoff, but all agree that at a certain point, high blood sugar levels indicate disease.

But psychiatric criteria cannot explain behaviors or experiences through any means beyond subjective opinion. Furthermore, as we’ve been exploring throughout the last few issues, these subjective opinions are rooted in norms and meaning. They can’t be measured independently, and they are not necessarily true across time and culture.

And yet, the flywheel of circular reasoning continues to spin, flinging the world of mental and emotional health further away from the solution. As British child psychiatrist Sammy Tammi said in his open letter on the diagnostic model of psychiatry to the Society of Humanistic Psychology, “The result of this basic [logic] error is that medical scientific knowledge in the area of mental health is at a standstill. No chemical imbalances, consistent neurological differences, genetic abnormalities or markers found. None. Billions of dollars of wasted money on wasted biological research that leads nowhere…higher levels of reported stress and anxiety, higher numbers of people disabled due to a mental health condition and rates of significant improvement from those attending mainstream services hovering at around a quarter to a third of those they see. These are not the outcomes you would expect to see from an effective model of clinical care.”

“When humans do not assume they have rather complete control of their experience, they do not so deeply fear those who have appeared to have lost it.”

—Juli McGruder, anthropologist

As of late, I’ve been learning about the different expressions of perceived mental illness around the world. I use “perceived” in this context because the more I learn, the more I understand that symptoms of mental/emotional distress are tied to cultural expectations. (See the TikTok tics from issue 105.) Said another way, the lifecycle of mental illness is influenced by the macro and micro-level beliefs that surround it. What’s considered crazy in one culture is accepted in another.

On a macro level, the prevalence and intensity of schizophrenia vary from place to place. Men living in urban areas of Sweden, for example, are at a 68% higher risk of being admitted for psychosis than those who live in the countryside. This is also true for urban settings in the United States and Europe, and it remains constant even when migration, drug use, and poverty are taken out of the equation.

Furthermore, a 25 year study conducted by the World Health Organization that began in the 1960s found that people diagnosed with schizophrenia in developing countries have better outcomes, longer periods of remission, and higher levels of social functioning than those in industrialized nations. Known as the International Pilot Study of Schizophrenia, the data showed that over time, 40% of schizophrenics in countries like the United States, Denmark, and Taiwan were considered “severely impaired” compared to 24% of people in countries like India, Nigeria, and Columbia.

Of course, these findings ignited a hot debate because the results are counterintuitive. You’d think all the money, research, and resources would lead to better outcomes. But alas, the data showed the opposite to be true.

(Side note, half a century later, our use of psychotropic medicine continues to reflect what we knew in the 1960s and 1970s. Are poor nations tragically underserved by psychiatry? Or have they avoided the crosshairs?)

This debate is the heart of cross-cultural psychiatry research. While it’s interesting in its own right and the conclusions are, to me, dead obvious, I find the micro influences to be even more interesting. It’s not just about the culture we live in. But the roof we live under.

Expressed emotion (EE) is a term used to describe the way that family members and caregivers interact with a person. High EE is characterized by critical, hostile, and emotionally overinvolved behaviors. Low EE is characterized by warm, supportive, and accepting behaviors. While expressed emotion is not the cause of distress, it can influence the course and outcome in an individual.

We all know that when our actions are met with criticism or hostility, we don’t fare as well. But emotional over-involvement requires more explanation.

Emotional over-involvment is characterized as a range of dramatic behaviors ranging from self-sacrifice, extreme devotion, overprotectiveness, or intrusiveness over a person’s life. Control, essentially.

Ethan Watters uses an example in his book, Crazy Like Us, that describes a mother who was so emotionally over involved with her son’s schizophrenia that she “dropped all other interests from her life. Her sole activity, she reported, was to take care of him and protect him, ‘like a pearl of a diamond.’ This same mother said that she often became so distraught over her son’s plight that she considered committing suicide by throwing herself down the family staircase.”

In addition to raising stress levels in the sufferer—which in this case, could trigger schizophrenic episodes—this maligned strategy is a constant reminder to the person suffering that those around him perceive him to be ill, which in turn, reinforces the idea that something is wrong.

Watters gives a contrasting example of a family in Zanzibar with a schizophrenic daughter, Kimwana, who overdosed her medication and nearly died. Juli McGruder, an anthropologist who witnessed the scene said, “There was no noisy woe-is-me talk or dramatic wringing of hands. [The family] seemed to take it in stride like everything else…When I asked what I could do, [the mother] told me I could take a carton of milk to Kimwana in the hospital.”

The ability for the family unit to keep calm and carry on benefitted Kimwana. The family’s perspective, in part because of Zanzibarian beliefs include spiritual possession, allowed everyone to embrace the idea that difficulties—and even voices in the head—are a natural part of life. Therefore, disruptive behavior as a result of these difficulties was more understandable and forgivable. Kimwana wasn’t viewed as other, or as someone to be feared. She was viewed as a strong expression of what we all have inside of us. This kept her within the social group.

Anglo-Americans have the highest level of expressed emotion compared to different groups around the world. Given that we no longer let our kids have sleepovers, have unsupervised play, or breathe without parental supervision, this shouldn’t be surprising. According to researcher Jill Hooley, Anglo-Americans have a strong “locus of control,” which means they believe a person can be master of their own fate and control their own issues through force of will. The critical, hostile, and emotionally over involved actions stemming from this locus of control aren’t necessarily cruel in intent, but are instead an expression of assumed (and flawed) human nature.

Cultures with more fatalistic or spiritual values place less focus and/or blame on those with mental and emotional distress. Conversely, in cultures that value personal accountability and individualism, highly emotionally involved relatives are actually more hopeful about the disease because they are convinced recovery is a matter of will—both on their part and the part of the sufferer.

But as they say in football (soccer), “It’s the hope that kills you.”

Watters says, “One typical father described his reaction to the schizophrenic break of his son: ‘I went to the library and began reading books about mental illness…I thought: “No, I’m going to fix this.” That is your first instinct as a parent. You’re going to fix it. I thought, “I can get him help. I can get him cured.”…That intense focus, even when it springs from a hopeful engagement of the problem, might be the very thing that exacerbates the illness.”

Furthermore, our obsession with the biomedical model of mental illness only exacerbates emotional over involvement. Take the following Euro-American norms:

By applying these norms to an individual, we separate them from the group by labeling them as Other, all while promoting the idea that recovery is never really possible. How could it be, if mental illness is nothing more than a stroke of bad luck and questionable genetics?

In 1997, Sheila Mehta of Auburn University got curious about whether or not the “brain disease” narrative of mental illness actually reduced stigma, as promised.

In her experiment, she paired up people for what test subjects thought was a simple learning experiment. Unbeknownst to the test subjects in the study, their partners were actors and were instructed to inform the test subjects during the get-to-know-you phase that they suffered from mental illness.

The actor told the test subject that the distress occurred because of the “things that happened to me when I was a kid or that they had “a disease just like any other, which affected my biochemistry.”

In the experiment, the test subject was assigned to teach the actor a pattern of button presses. When the actor got the pattern wrong, the test subject was told to give the actor a “barely discernible” to “somewhat painful” electric shock.

Test subjects who believed their partner had a “disease like any other” increased the severity of shocks at a faster rate than those paired with the actor whose issues were caused by childhood events.

Mehta said, “The results of the study suggest that we may actually treat people more harshly when their problem is described in disease terms. Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.“

And what is our instinct when we encounter Other? Critical, hostile, and emotionally over-involved behaviors.

So it goes.

As of late, I’ve become fascinated with the idea that mental illness is contagious.

The fascination started with a New York Times article about a wave of thousands of female and gender-nonbinary teens who developed Tourette’s-like tics during the pandemic—because of TikTok.

Arriving in the zeitgeist when people were forced to stay home, TikTok exploded during the pandemic. Videos of people claiming to have Tourettes multiplied on the platform, and because TikTok’s algorithm is built on showing users a wide variety of content—regardless of the user’s preferred interests—Tourette’s videos began popping up on people’s feeds. As of this writing, #Tourettes on TikTok has 8.7 billion views.

Like mental illness, there aren’t any scans or biological markers to diagnose or identify Tourettes. However, Tourettes is categorized as a movement and neurological disorder marked by uncontrolled physical or verbal tics, not a mental illness. It typically presents in males and first appears in childhood, with waxing and waning symptoms.

For the girls with “TikTok Tics,” however, the Tourettes-like symptoms arrived suddenly, with a wave of new cases popping up all over the world. Notably, though, when life began to regain some normalcy and the stress of the pandemic waned, the wave of TikTok Tics receded as well. Thus, it is hypothesized that the unique stress of the pandemic + the unique vulnerability of teenage girls created a tinderbox of stress that manifested in psychologically contagious tics.

This isn’t the first time we’ve observed psychological contagion. This phenomenon repeats itself across both time and cultures. In the Middle Ages, it was believed that humans could be possessed by the spirits of demonic animals, leading a group of nuns at a French convent to meow like cats.

In the 1800s, “hysteria” was a known psychological diagnosis that afflicted women. It included a diverse range of symptoms, including paralysis, stomach pain, amnesia, and day blindness. Hysteria was almost worshiped and certainly fetishized by popular magazines, newspapers, and even public hygiene literature. Much like today, male doctors and scholars of the time filled lecture halls and pontificated on the “quintessential illness of womanhood,” as Ethan Watters said in his book, Crazy Like Us. But by the time the 20th century rolled around, hysteria had largely evaporated from the collective consciousness. Women stopped reporting paralysis and leg weakness, and the symptoms of psychosomatic illness moved on to other expressions.

Even the human reaction to war is tied to the cultural temperature. Medical records of war veterans show that the psychological and even physical effects of war are a reflection of time and place. For British soldiers in the Boer War, the psychological trauma manifested as muscle weakness and joint pain, while American soldiers during the Civil War complained of a weak heartbeat and an aching in the left side of the chest. During World War I, both British and American soldiers experienced “shell shock,” with symptoms that included tremors, ticks, and sensory disturbances. Today, addiction affects veterans of modern war.

As Watters explains, “Although the potential psychic damage of war is indisputable, the process by which that damage becomes an outward symptom is a reflection of the cultural beliefs in a particular time and place.”

Said another way, whether as a PTSD response to war or TikTok, people will unconsciously produce symptoms that reflect the culture’s prevailing cultural diagnosis of the time. The TikTok Tics were not so much a measurable illness, but a subconscious yearning for recognition of internal distress.

The implications of viewing mental illness through this lens, in my opinion, destabilize the entire foundation of psychiatry and psychology. I know, for example, that as a young ballet dancer, the eating disorders I experienced as a teenager were created through community. Anorexia is rampant in ballet not just because thinness is an aesthetic ideal, but because everyone else is doing it. Toss in the death of my father and the emergence of the internet in the early 2000s, and the fixation on thinness festered as a direct result in order to satisfy a need to belong to something while expressing suffering. There wasn’t ever anything wrong with my brain. If anything, it was a sign that my psyche was doing exactly what it should be expected to do in times of great stress. I was simply exhibiting symptoms consistent with the time—no different than if I had started meowing with nuns in the Middle Ages.

For an affliction to be pathological, it seems to me that it should ring true across both time and culture. A cancerous mass viewed under a modern microscope looks the same in Taiwan as it does in the United States. But if mental illness and psychological distress cannot be separated from the culture in which it is experienced, how is a blanket biomedical response ever going to be the answer?

Hi friends,

I’m writing to you today from Brooklyn, where I’ve been for a month. I’m here taking a six-week public speaking workshop in the hopes of creating a straight-ish shot to a career that can be supported by speaking on antidepressant withdrawal and depression recovery. Like most endeavors, there’s a way to have a small impact and there’s a way to go big. I want to go big, so I’m taking the time to dedicate focus and level up.

(Now would be a good time to mention that I am available for booking for 2024. I’d love to speak at your business, conference, or university event. Please reach out to me at brooke@brookesiem.com.)

Spending an extended period of time in another environment illuminates cracks in the world I’ve built for myself. I first discovered this in the depths of antidepressant withdrawal, when I boarded a one way ticked to Malaysia six months after getting off of Effexor. I’d committed to a year of international travel before I took my last antidepressant, thinking that I had plenty of time to get off the cocktail of prescriptions I’d been on as a teenager. I figured I’d feel like I had the flu for a week or two, start taking a new antidepressant that would surely work wonders, and flit off around the world in an Eat, Pray, Love fantasy.

Instead, I had a withdrawal experience so horrific, I would eventually sell a book about it. LOLz.

As difficult as it was to travel while in antidepressant withdrawal, it accelerated my healing. I was changing countries every five weeks, which meant I had enough time to settle into a new place, but not enough time to create a home. This forced me into a minimalist lifestyle. If it didn’t fit in one suitcase and a backpack, it couldn’t come with me.

This exercise in pairing down spotlighted what was actually important and what was a story I was telling myself. Prior to leaving the United States, for example, I made room in my suitcase for a travel steamer to keep my clothes crisp. After three weeks in Malaysia, both the steamer and most of the clothes I brought with me were given to goodwill. The steamer was useless in the oppressive humidity, as were clothes that required steaming. It wasn’t just about lightening up the suitcase. It was about changing the focus from how I thought I needed to present myself to what I actually needed to feel good. In Malaysia, I wasn’t surrounded by folks who looked like me or thought like me, so I didn’t have a chance to be influence by their choices. It was about what I needed and how I wanted to feel. But it took being in a completely different physical location for me to start understanding that.

Emotionally, I went through the same process. For years, I’d created a story for myself that blamed my problems on outside influences. I was depressed because of my business partner, my finances, or a lack of romance. But in choosing to leave my life, I stripped myself of all those external factors. I couldn’t blame my misery on my business partner when I was no longer part of the business.

Unlike the practicalities of luggage, unpacking my emotional baggage took longer than three weeks. I needed to move around a few times to notice what triggers came with me and what didn’t. It was only after I noticed that I had the same problem in Malaysia as I did in Cambodia that I was able to come to the conclusion that maybe the problem was me.

This was terrible news. And great news! It meant I had the power to do something about it but I also had to do something about it, which is always unpleasant and involves a lot of ugly crying. But as I practiced the muscle of identifying the issues inside me, I got better at clearing them up without all the drama.

Over and over again, with each new country, I evaluated the contents of my suitcase in relation to where I was in the world. By the end of the experience, I was traveling only with a carry on, the contents of which could sustain me on chilly Argentinian nights or warm Mexican days. And I’d stripped myself off all the emotional bullshit too.

Over the years, I’ve continued this practice (save for that pesky pandemic which complicated matters.) Here and there I seem to spend a couple of months in another place and see what it has to teach me. It slows down time, puts what matters into focus, and shows me what to clear out. A few months in Vancouver, Canada ultimately led to an important relationship and semi-permanent relocation to the Great White North. A summer in Seattle produced MAY CAUSE SIDE EFFECTS. This time in Brooklyn is showing me how much I’ve healed since I left New York City seven years ago, while also highlighting the need for me to leave the comfortable but anemic existence I fell into during covid. Honing, honing, honing.

I realize that I’m in a unique position to do this. I don’t have kids and my work is relatively flexible. But the lesson can be learned without getting on a plane. All it takes is an honest assessment of what’s not working in your life and forcing yourself to experiment with different choices around that issue. Few things in life are irreversible. Commit for two months and see what happens. Maybe you cut out coffee, stop watching the news, or finally see a therapist or counselor. Whatever it is, it’s got to be long enough to settle into, but short enough to know you can handle the inevitable unease that comes with it. Two months, I think, is the sweet spot.

What comes of this practice is the ability to question what you believe about the world. This intellectual flexibility makes for interesting and resilient people who are thoughtful, adaptable, and unlikely to be manipulated. It also has the beautiful side effect of slowing down time, because when you’re consciously paying attention to the reverberations of new choices, you can’t act on autopilot. With a world moving at an ever increasing speed, any chance to slow it down is a welcome gift.

In the 100th issue of Happiness Is A Skill, I revealed that I underwent genetic testing through GeneSight in order to get an insight into how my body metabolizes psychiatric drugs. My results are in, and we’re going to take a look at them together in order to better understand this technology, while also examining some of the limitations and concerns around this type of testing.

I recommend reading through issue 100 before diving in here.

Please note that I have no affiliation with GeneSight, and this is in no way an advertisement or medical advice.

The GeneSight report focuses on three different aspects of psychiatric drug metabolism: psychotropic, which indicates how a person is likely to metabolize a wide variety of psychiatric drugs; genotype and phenotype, which is the organism’s genetic information and its observable traits; and a gene-drug interaction chart.

In theory, this information aims to optimize medication choices by reducing trial-and-error prescribing. Given that I’m not in the business of taking psychiatric drugs ever again, I’m more interested in the insight this gives me into my own body, and what it might mean for psychiatric drug withdrawal. Big emphasis on might. I won’t be running any double blind, placebo controlled trials on the hypothesis any time soon, but seeing this information and understanding what it means does make me think twice about blindly taking prescription drugs. Personally, I think that’s the power of a test like this. It shows the layperson that pharmaceutical intervention is extremely complicated, while also increasing the patient’s medical literacy. Given that on average, doctors only spend 17 minutes with each patient—and 4.5 hours per day on electronic medical records—it behooves the patient to have some basic medical literacy before walking into an appointment.

Genesight gives psychotropic results for five drug categories: antidepressants, anxiolytics and hypnotics (anti-anxiety and sedatives), antipsychotics, mood stabilizers, stimulants & non stimulants.

The results are coded in green (use as directed), yellow (moderate gene-drug interaction), and red (significant gene-drug interaction.)

Intuitively, you can gather that green medications are not associated with any known genetic issues that would be expected to change patient medication outcomes; yellow medications may require dose adjustments in order to have the desired effect and may be less likely to work/may cause side effects; and red mediations are likely to require significant dose adjustments in order to have the desired effect, or they not work at all, and may cause side effects.

The number to the right indicates the rationale for the reason why a drug is in the yellow or red column. This is where things get interesting when viewed through the lens of my personal history.

Before my child psychiatrist landed on a combination of Wellbutrin XL and Effexor XR, he gave me at least two other drug that created obvious, immediate side effects. I don’t remember which drugs they were and the medical records have long been destroyed, but given the antidepressant market in 2001/2002, it was likely to be Prozac, Celexa, or Zoloft—all of which exist in my yellow column.

Effexor, too, is on my yellow list. While I know I didn’t have immediate side effects from my 37.5mg dose, Effexor withdrawal was pure hell. While there aren’t any clinical studies looking at the relationship between the CYP450 system and psychiatric drug withdrawal, it doesn’t seem like a radical leap to assume that someone’s ability to metabolize a drug also affects the body’s ability to get the drug out of the system. Anecdotally, this hypothesis is further bolstered by my relative ease when it came to getting off the Wellbutrin, a drug in my green column. I know this isn’t the whole story, but it seems unlikely that it’s not somehow related.

Another reason why I find this test valuable is because of the information buried in the anxiolytics and hypnotics results. Many of these drug are commonly prescribed as part of surgical procedures in hospitals. If I ever needed major surgery, I’d want my anesthesiologist to have these results. Whether or not they’d take them into consideration is another matter, but I’ve given a copy to my emergency contact, just in case.

The genotype and phenotype type results show specific variants for each gene. These results explain why drugs end up in the green/yellow/red column.

It is broken down into two categories: Pharmacodynamic and pharmacokinetic.

Pharmacodynamic genes provide insights into how medications interact with the body. Variations in these genes can impact the likelihood of response or the risk of side effects with certain medications.

While it is important to note that many genes—including ones not tested by GeneSight—are involved in the process of metabolizing psychiatric drugs, GeneSight has identified a handful of issues known to come with specific gene variants. SLC6A4, for example, encodes for the serotonin transporter, which is the main site of action for SSRIs. People have either a long allele (variation) or short allele of SLC6A4. According to GeneSight, “Studies have shown that the short [SLC6A4] allele results in less serotonin transporters than the long allele. Individuals who have the short allele may be less likely to respond to certain SSRIs based on this genotype.” Thus, my short SLC6A4 allele contributes to the reason why SSRIs like Celexa, Paxil, and Zoloft are on my yellow list.

The same goes for pharmacokinetic genes, which provide information about how the body processes medications.

What stands out here is my CYP2D6 and CYP1A2. CYP2D6 is involved in a wide range of drug metabolism, psychiatric and otherwise. My intermediate metabolizer status indicates that I metabolize these drugs more slowly than normal. This is important because it means that while I may not have immediate adverse reactions, I am more likely to encounter them long term as the drug slowly builds up in my system.

On the other end of the spectrum, I am an ultra rapid metabolizer for CYP1A2. CYP1A2 is involved in the metabolism of a not only some antipsychotics, but also melatonin and caffeine. This explains two things I’ve known to be true about myself: I can drink caffeinated coffee or tea late in the day without it affecting my sleep, and melatonin has little to no effect on me. This makes sense—thanks to my quick CYP1A2, both caffeine and melatonin rush right through my system.

Additionally, vegetables like cabbages, cauliflower and broccoli are known to increase levels of CYP1A2, whereas spices like turmeric and cumin inhibit CYP1A2. So much so that a Sydney based researcher concluded that the “different diets and lifestyles of South Asians compared to Europeans could lead to the two groups requiring very different doses of medicines commonly used to treat illnesses such as depression and psychosis.”

Said another way: diet affects drug metabolism.

Of course, most of us aren’t thinking about how that chai tea affects the efficacy of our Rx cocktail. For the majority of people, it’s this particular quirk probably irrelevant. But for others—say, someone living in a Sri Lankan household who is struggling with a particular prescription drug—the knowledge might be more akin to low hanging fruit.

Furthermore, it speaks to the nuance of drug prescription that is all but ignored. Now, I know that any drug or supplement I take should be crossed checked to see if it’s metabolized by CYP1A2 or CYP2D6. If so, maybe I need to stay away from Indian food while I take it or consider a change in dose.

The last chunk of the GeneSight test is a handy chart outlining gene-drug interaction. The chart is supplementary, and only tells you which genes are involved in metabolizing each drug.

The real limitation here is that the second multiple drug are involved, all of this goes out the window.

You now know that a drug-gene interaction occurs when a person’s genetic makeup affects how their body metabolizes or responds to a medication. A drug-drug-gene interaction occurs when the effects of two or more medications are altered by a person’s genetic makeup.

For example, someone who is an intermediate metabolizer for CYP3A4—one of the enzymes involved in Zoloft (sertraline) metabolizatoin—may have no issue with the Zoloft alone, even as an intermediate metabolizer. But serotonin toxicity, also know n as serotonin syndrome, becomes a real risk if they start taking the antibiotic erythromycin. Erythromycin uses the CYP3A4 pathway and therefore inhibits the metabolism of Zoloft, leading increased and potentially toxic Zoloft levels in the body.

While the Zoloft or the erythromycin individually may not create an issue, combine them together with an intermediate or slow metabolizer, and you’ve got a problem.

GeneSight isn’t of any help when it comes to drug-drug-gene interaction, a giant limitation given how many people are on multiple drugs. But again, it gives us more information than we had before, which I think is a net positive.

In general, I went down the GeneSight rabbit hole for no reason other than pure curiosity. I have no plans to take psychiatric drugs in the future, nor do I know how my trajectory might have been different had I had this information back when I was medicated in 2001.

There is plenty of debate about the use of genetic testing in the world of mental health, most of it focusing on questions about privacy, accuracy, over interpretation of the results, lack of FDA approval, and cost.

From my perspective, there’s not enough compelling evidence to convince me that people shouldn’t take it into consideration. We do all sorts of things that aren’t approved by the FDA—drinking wine and taking multivitamins, for example—so that argument is moot. Privacy concerns are ubiquitous these days, but I personally don’t care what they do with my results. Some think that the results could inhibit people from getting insurance to pay for psychiatric care down the line, but again, I haven’t seen direct evidence of this.

Like anything, it’s up to the individual to decide what’s best for them.